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Children with epilepsy rate mental health and social support important to QoL

medwireNews: Clinicians should look beyond seizures to improve the quality of life (QoL) of children with epilepsy, child self-report findings show.

The research, published in Neurology, highlights mental health and social support as being strongly related to epilepsy-specific QoL, from the perspective of children aged 8 to 14 years. Seizure status was only weakly associated with QoL and only indirectly through its effects on mental health.

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Researcher Nora Fayed (McMaster University, Hamilton, Ontario, Canada) and colleagues used a structural equation modelling approach in their assessment of 480 children aged an average of 11.4 years. The children were on medication for their seizures and all scored above 70 for receptive vocabulary and were therefore able to self-report.

They found that peer support, parental support, IQ, the mental health of the child and seizure status were able to explain 45% of the variance in QoL, measured using the Child Epilepsy and QOL Questionnaire.

Child mental health, peer support and parental support showed strong, direct associations with QoL, with standardized coefficients of 0.27, 0.35 and 0.19, respectively. Parental support, however, showed a stronger indirect association with QoL through mental health. Similarly, verbal IQ was more strongly associated with QoL through mental health, with a standardized coefficient of 0.13.

Seizure status was only weakly associated with QoL and indirectly through mental health, with a standardized coefficient of –0.16.

“The strong direct relationship between peer support and QOL implies that interventions geared toward peers could have an immediate and palpable effect on child QOL”, the researchers comment.

“Interventions that do precisely this have been offered by community groups and have demonstrated effectiveness; however, referrals to such programs might be underused by epilepsy clinical programs.”

In a related editorial, Janelle Wagner and Tanja Kellermann, from the Medical University of South Carolina in Charleston, USA, say the current findings “inform clinical practice in the treatment of epilepsy by suggesting that clinicians should focus on patient-reported outcomes, such as epilepsy-specific QOL, in addition to seizure control and treatment of adverse effects.”

They add, however, that “the most comprehensive picture of child well-being integrates child report with parent report because there are some domains in which parents are more adept reporters of function (e.g., impulsivity, oppositional behaviors).”